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NPI Code Detail

MEDICARE: DR. RAQUEL NOWAK PSY.D.

MEDICARE:  DR. RAQUEL  NOWAK  PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist071.009820IL

General Provider Information

NPI Number : 1093298259
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAQUEL NOWAK PSY.D.
Provider Business Mailing Address
First Line : 5659 S KOLIN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4838
Country : US
Telephone Number : 773-888-2586
Fax Number :
Provider Business Practice Location Address
First Line : 9631 W 153RD ST STE 38
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-3778
Country : US
Telephone Number : 773-888-2586
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2018
Last Update Date : 09/12/2018

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Directions to “ DR. RAQUEL NOWAK PSY.D.” Practice Location

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